Basic Information
| Provider Information | |||||||||
| NPI: | 1598889008 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARABI | ||||||||
| FirstName: | ALIREZA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 370141 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891370141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832691 | ||||||||
| FaxNumber: | 7023884114 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 SHADOW LANE # 200 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023832691 | ||||||||
| FaxNumber: | 7023884114 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 11/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 13143 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 13143 | 01 | NV | MEDICAL LICENSE | OTHER | CS18077 | 01 | NV | PHARMACY LICENSE | OTHER | FF1336937 | 01 | NV | DEA CERTIFICATE | OTHER |